Thursday, March 31, 2011

Sensitivity of HHV-6 to Antiviral Agents

Ganciclovir CYTOVENE™Ganciclovir is a drug used to treat CMV retinitis. It is available in both oral and intravenous forms. Studies have shown that HHV-6 replication is effectively suppressed by intravenous ganciclovir and the drug has been used to successfully treat life-threatening HHV-6 infections of the brain and spinal cord in bone marrow transplant recipients.

Ganciclovir is the only drug that has demonstrated its ability to successfully treat brain infections by HHV-6.

Treatment with intravenous ganciclovir may cause potentially serious side effects, most commonly bone marrow suppression. Oral ganciclovir is available, but it produces relatively low serum levels of the drug and is unlikely to be highly effective against established HHV-6 infections.

Valganciclovir VALCYTE™ Recently, the valine ester of ganciclovir (valganciclovir or VALCYTETM) has been developed by Roche Pharmaceuticals as an antiviral drug, and it was recently FDA approved for use in the treatment of cytomegalovirus retinitis in patients with AIDS. Valganciclovir is a prodrug of ganciclovir in that it is rapidly converted to ganciclovir by intestinal and hepatic enzymes producing plasma levels of drug that are similar or even superior to those achieved by intravenous ganciclovir. Valganciclovir is administered orally twice per day.

Acyclovir ZOVIRAX™ Acyclovir is used to treat herpes simplex (HSV), varicella zoster (VZV) infections. It is available in oral form. Available data indicate that HHV-6 is relatively insensitive to the inhibitory effects of acyclovir. The mean inhibitory concentration 50% (IC50) of acyclovir for HHV-6 strains is approximately 30 uM, a concentration well above the plasma levels achievable with either oral or intravenous therapy.

Acyclovir VALTREX™Valacyclovir or VALTREX is an orally delivered drug chiefly used to treat HSV and VZV. It is a prodrug of acylovir, meaning that it is converted to active acyclovir within the body. This results in higher levels of drug in the blood stream and it is believed that this level of drug might be partially effective against HHV-6. Valcyclovir has been used to effectively decrease the incidence of HHV-6 associated disease in bone marrow transplant recipients. Thus it is effective against reactivation of HHV-6, but may not be effective in suppressing an active, chronic infection. Studies have also demonstrated that VALTREX therapy at standard dosages is associated with a low rate of adverse side effects. Thus, VALTREX treatment stands as a potential alternative for long-term therapy for HHV-6 associated diseases, especially in combination with another antiviral drugs such as beta interferon.

Nonconventional Antiviral AgentsSeveral preparations of various types have been assessed for their ability to suppress the replication of HHV-6 in cell culture. The potential for these agents to be used in the clinical setting remains unclear, and little or nothing is known concerning their pharmokinetics or the plasma levels they can achieve.

One of these is AMPLIGEN, approved for use in Canada and Belgium, but not in the U.S. The Ampligen web site states that results of trials in the U.S. and Belgium "suggest that Ampligen may be an effective treatment for a certain subset of Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) patients, namely those with severe debilitation." The structure of this drug is similar to a known interferon inducer and this strongly suggests that any suppressive effect Ampligen may have on HHV-6 replication is mediated by interferon. Ampligen is a synthetic, mismatched, double-stranded RNA, and a single report of its ability to inhibit HHV-6 replication has been published. Read more>>

"Plenty of people are still dying of diseases which other people do not believe." (Dr. M.N.C. Dukes).CBT and GET for ME: "There is no nonsense so gross that society will not, at some time, make a doctrine of it and defend it with every weapon of communal stupidity."

Robertson Davies

THE NICEGUIDELINES BLOG VERSUS THE NICEGUIDELINES

These are NOT the NICEGuidelines. This is "The NICEGUIDELINES BLOG." What are the differences:

The NICE Guidelines are biased publications based on the GOBSART (Good Old Boys Sitting Around a Table) approach.

This Blog however is not only evidence based but also uses critical reading to judge papers and articles. I also use common sense and listen to others. And finally I read both psychiatric and medical evidence and opinions from around the world to come to a conclusion.

I’m not sponsored by anybody or paid by whatever company as seems to be the norm with many psycho people who publish the same article almost on a weekly base.

So if you value an opinion, formed as a result of participating in many ME activities, for example being bed bound for years, you have come to the right BLOG. All these activities have allowed me to form an opinion as a Doctor and as a Patient. And that is important as the voice of the latter is discarded by many including NICE.

If you don’t read this blog, you will miss out on “accredited” medical education. If you do read it, you may actually become a doctor who doesn’t stop thinking or forgets to ask critical questions. Many good things, including satisfied patients are at your command.

So, if you arrived here for the straightforward GOBSART approach, I will disappoint you. If you are interested in forming your own opinion about ME, and other interesting things, read on!

About Dr. Speedy.

I am a Family Physician or GP as it is called in Australia or the UK. I am also an ME patient unfortunately. Bedbound that is. So at the moment I’m in private practice so to speak. I’ve got only one patient, ME, or is it me?

I graduated as a doctor a long time ago, and I am the founder and editor of The NICEGUIDELINES BLOG, an internet based ME BLOG that is devoted to critical reading and cheering you or ME up.

I have the following conflict of interest: I would like to get better and see that the wasting of public money on CBT (talk therapy for a neurological disease, really helpful) and other silly therapies for ME stops, and will be used in better ways.

My goal has always been to help, and if possible, cure patients. With this disease you will soon find out that many psychiatrists and psychologists are only in it to make money and get their name in the spotlight. And what happens to and with the patients is irrelevant.

I stand to benefit both mentally, physically and also financially if this silliness would stop, and I would get my health back, and I can go back to work and have a normal life again. Please evaluate my postings with this in mind! And remember, there are also (lots of) psychiatrists and psychologists who haven’t switched their brain off.